© iStock/twigymuleford An examination of how medical cannabis could be used to combat the abuse of various substances and addiction disorders.
Humans enjoy sampling a variety of extreme stimuli. These behaviours may be risky (such as persistent gambling, drinking or smoking), repetitive to the exclusion of normal interpersonal interactions (such as gaming), unhealthy (such as overeating), or resulting in a sense of euphoria or a ‘high.’ Some of these behaviours can become excessive and psychological or physical cravings lead to the behaviour overtaking the usual activities of daily living. Where physical cravings are involved, the serious nature of substance use disorder (SUD) has come into focus as more than 130 people in the United States die every day after overdosing on opioids (CDC, 2018). Clearly, effective treatment strategies are in short supply.
The endocannabinoid system may suppress addictive urges
The body’s endocannabinoid system (ECS) consists of receptors which mediate a variety of functions ranging from cognition, memory, mood, appetite and sensory responses (Chye, 2019). The ECS’s role in reward signalling may influence repetitive behaviour. Cannabidiol (CBD) is a phytocannabinoid found in cannabis plants but not made in the human body.
Nevertheless, it can interact with ECS receptors (CB1R in particular) to provide a therapeutic strategy for addictions. CBD is ‘non-rewarding’ and acts to mediate responses in a number of receptor systems including the opioid, serotonergic, and endocannabinoid systems (Chye, 2019). With cannabinoids acting directly on ECS receptors, it is clear that medical cannabis could have potential success as a substance abuse treatment option.
Cannabis for the treatment of substance use disorder
Drug addiction, now known as substance use disorder (SUD), is characterised by repeated use of a drug or substance leading to clinically significant distress. Over time, this becomes a health threat to the affected individual, as well as to their community (Chye, 2019). The most common substances involved in SUDs include both prescription and illicit opioids, commercially available nicotine and alcohol, and illicit cocaine and methamphetamine (APA, 2013). Available treatment options include behavioural counselling, medication, medical devices and pharmaceuticals (there are three FDA-approved options) to address both the physical and psychological aspects of drug abuse, but they are clearly not effective or available enough. Cannabinoids offer a possible additional option.
Cannabis as an alternative to opioid use
Opioids are typically used for pain reduction, but have the additional effects of drowsiness, mental confusion, euphoria, nausea and constipation. This class